In Other Words Secure Contribution Form

Become a member of In Other Words' feminest and join your community in sustaining our community center while promoting gender equality,
education, and activism!

Secure Credit Card Donation Form

Please note that fields with an asterisk (*) are required.

*Please indicate Gift Amount:  .00               
*Please indicate Gift Frequency: 

If you chose a monthly frequency, your credit card will be charged today for your first donation.
Below, please choose the date you would like us to charge your account for future donations.
(Your first two monthly donations may appear on one credit card statement depending on your statement date.)

This donation is in honor of:  

*First Name:   *Last Name:  
*Address 1:   Address 2:   
*City:   *State/Province/Other:  
*Zip/Postal Code/Other:   *E-mail Address:  
*Daytime Phone #:   Evening Phone #:  

*Payment Type:    Credit Card   Check 

If by Credit Card:
*Credit Card Type:  
*Credit Card Number:  
*Expiration Date:   /

If by Check:
*Bank Account Number:  
*Routing Number:   Where can I find this?

Would you like to receive our monthly calendar of in-store events?   Yes   No 
Comments or suggestions:

After ensuring that all of the information above is correct,
please click the Submit Form Now button ONLY ONCE.
Multiple clicks of the Submit button will result in duplicate charges to your account.
An email confirmation will be sent to the email address you provided.


In Other Words
14 NE Killingsworth
Portland, OR 97211
Phone:503-232-6003 Email

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